Abstract
Background
Surgical management of pediatric hypervascular brain tumors is challenging because of the risk of bleeding. We sought to evaluate the technical factors associated with safety and outcome of preoperative embolization of pediatric hypervascular brain tumors.
Materials and methods
Eight pediatric brain tumor patients received preoperative endovascular embolization during the past 8 years. The cases included four choroid plexus papillomas, one yolk sac tumor, one intraventricular meningioma, one astrocytoma, and one hemangioblastoma. Embolization was done by superselection of the feeding arteries with microcatheters followed by slow injection of either n-butyl 2-cyanoacrylate (NBCA) or tris-acryl gelatin microspheres (Embosphere). Surgery for tumor removal was done in the same session right after embolization in all but one patient. Blood loss during surgery and clinical outcome were recorded.
Results
Preoperative embolization was successfully done in all patients. Technical complication was noted in two patients. One patient developed bleeding while embolizing the tumor with Embospheres but was immediately embolized with NBCA without sequel. The other patient experienced tumor bleeding 4 h after embolization with Embospheres, and suffered left hemiparesis despite an emergency surgery. Surgical intervention was successfully done in all patients without procedure-related complication. Surgical blood loss ranged from 50 to 1,600 ml.
Conclusion
Though associated with the risk of procedure-related bleeding, preoperative embolization of pediatric hypervascular brain tumors has high technical success rates and can enhance the surgical management. We suggest to perform the embolization and surgery in a single session and to use NBCA as the embolic agent to minimize the procedure-related risk.
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References
Deshmukh VR, Fiorella DJ, McDougall CG, Spetzler RF, Albuquerque FC (2005) Preoperative embolization of central nervous system tumors. Neurosurg Clin N Am 16:411–432
Heuer GG, Jackson EM, Magge SN, Storm PB (2007) Surgical management of pediatric brain tumors. Expert Rev Anticancer Ther 7(12 suppl):S61–S68
Brismar J, Cronqvist S (1978) Therapeutic embolization in the external carotid artery region. Acta Radiol Diagn 19:715–731
Gruber A, Killer M, Mazal P, Bavinzski G, Richling B (2000) Preoperative embolization of intracranial meningiomas: a 17-year single center experience. Minim Invasive Neurosurg 43:18–29
Takeuchi S, Tanaka R, Fujii Y, Abe H, Ito Y (2001) Surgical Treatment of hemangioblastomas with presurgical endovascular embolization. Neurol Med Chir (Tokyo) 41:246–251
Eskridge JM, McAuliffe W, Harris B, Kim DK, Scott J, Winn HR (1996) Preoperative endovascular embolization of craniospinal hemangioblastomas. AJNR Am J Neuroradiol 17:525–531
Horton JA, Eelkema E, Albright AL (1989) Preoperative embolization of a hemangioblastoma. AJNR Am J Neuroradiol 10:203
Tampieri D, Leblanc R, TerBrugge K (1993) Preoperative embolization of brain and spinal hemangioblastomas. Neurosurgery 33:502–505
Vázquez-Añón V, Botella C, Beltrán A, Solera M, Piquer J (1997) Preoperative embolization of solid cervicomedullary junction hemangioblastomas: report of two cases. Neuroradiology 39:86–89
Nagib MG, O’Fallon MT (2000) Lateral ventricle choroid plexus papilloma in childhood: management and complications. Surg Neurol 54:366–372
Do HM, Marx WF, Khanam H, Jensen ME (2001) Choroid plexus papilloma of the third ventricle: angiography, preoperative embolization, and histology. Neuroradiology 43:503–506
Pencalet P, Sainte-Rose C, Lellouch-Tubiana A, Kalifa C, Brunelle F, Sgouros S, Meyer P, Cinalli G, Zerah M, Pierre-Kahn A, Renier D (1998) Papillomas and carcinomas of the choroid plexus in children. J Neurosurg 88:521–528
Otten ML, Riina HA, Gobin YP, Souweidane MM (2006) Preoperative embolization in the treatment of choroid plexus papilloma in an infant. Case report. J Neurosurg 104(6 Suppl):419–421
Haliasos N, Brew S, Robertson F, Hayward R, Thompson D, Chakraborty A (2012) Preoperative embolisation of choroid plexus tumours in children: part I—does the reduction of perioperative blood loss affect the safety of subsequent surgery? Childs Nerv Syst 29(1):65–70. doi:10.1007/s00381-012-1912-8, Epub 2012 Sep 26
Kallmes DF, Evans AJ, Kaptain GJ, Mathis JM, Jensen ME, Jane JA, Dion JE (1997) Hemorrhagic complications in embolization of a meningioma: case report and review of the literature. Neuroradiology 39:877–880
Bendszus M, Monoranu CM, Schütz A, Nölte I, Vince GH, Solymosi L (2005) Neurologic complications after particle embolization of intracranial meningiomas. AJNR Am J Neuroradiol 26:1413–1419
Carli DFM, Sluzewski M, Beute GN, van Rooij WJ (2010) Complications of particle embolization of meningiomas: frequency, risk factors, and outcome. AJNR Am J Neuroradiol 31:152–154
Dowd CF, Halbach VV, Higashida RT (2003) Meningiomas: the role of preoperative angiography and embolization. Neurosurg Focus 15:E10
Kim LJ, Albuquerque FC, Aziz-Sultan A, Spetzler RF, McDougall CG (2006) Low morbidity associated with use of n-butyl cyanoacrylate liquid adhesive for preoperative transarterial embolization of central nervous system tumors. Neurosurgery 59:98–104
Acknowledgments
We thank Dr. Hui Meng for editing the manuscript.
Sources of funding
This work was supported by National Science Council grant NSC 98-2314-B-075-040-MY3 and Center of Excellence for Cancer Research at Taipei Veterans General Hospital grant DOH100-TD-C-111-007.
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Wang, HH., Luo, CB., Guo, WY. et al. Preoperative embolization of hypervascular pediatric brain tumors: evaluation of technical safety and outcome. Childs Nerv Syst 29, 2043–2049 (2013). https://doi.org/10.1007/s00381-013-2128-2
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DOI: https://doi.org/10.1007/s00381-013-2128-2